Secondary Prophylaxis of Hepatic encephalopathy in Liver cirrhosis: Rifixamine plus Probiotics vs. Rifixamine alone
Khurram Shahzad1, Shahid Sarwar2, Samina Saeed3
1Dr. Khurram Shahzad, FCPS (Medicine) Post Graduate Resident, Department of Medicine, Jinnah Hospital, Lahore, Pakistan.
Pakistan Journal of Medical Sciences
|April 17, 2026
Summary
Adding probiotics to rifaximin significantly reduced hepatic encephalopathy recurrence in liver cirrhosis patients. This combination therapy offers a more effective strategy for secondary prevention compared to rifaximin alone.
Area of Science:
- Gastroenterology and Hepatology
- Microbiome Research
- Clinical Pharmacology
Background:
- Hepatic encephalopathy (HE) is a serious complication of liver cirrhosis.
- Secondary prevention of HE recurrence is crucial for patient outcomes.
- Rifaximin is a standard treatment, but its efficacy can be enhanced.
Purpose of the Study:
- To evaluate the efficacy of combining probiotics with rifaximin for secondary prevention of HE in liver cirrhosis patients.
- To compare this combination therapy against rifaximin monotherapy.
Main Methods:
- A quasi-experimental study involving 120 liver cirrhosis patients with a history of HE.
- Patients were randomized into two groups: rifaximin + Saccharomyces boulardii probiotics (Group-A) or rifaximin alone (Group-B).
- Follow-up was for six months to assess HE recurrence rates.
Main Results:
- HE recurred in 15% of patients in Group-A versus 38.3% in Group-B (p=0.004).
- Baseline characteristics were comparable between groups, indicating treatment regimen as the key factor.
- No significant differences in recurrence were observed based on age, disease duration, or lab parameters, underscoring the treatment's impact.
Conclusions:
- The addition of probiotics to rifaximin significantly reduced HE recurrence.
- This combination therapy represents a more effective strategy for the secondary prevention of hepatic encephalopathy in liver cirrhosis.
- Probiotics may potentiate the benefits of rifaximin in managing HE.
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